Aliasing artifact depicted on ultrasound (US)-elastography for breast cystic lesions mimicking solid masses

It has been reported that ultrasound (US)-elastography is helpful in differentiation of benign and malignant solid masses and in reducing benign biopsy procedures for the supplemental breast US in addition to screening mammography. Furthermore, potential application of US-elastography in distinguishing cystic lesions which is known to be a major source of benign biopsy results has been suggested.

To describe the aliasing artifact on US-elastography for breast cystic lesions that mimic solid masses.

We retrospectively reviewed 13 lesions which showed a blue-green-red pattern artifact on US-elastography in 13 women (mean age 50 years; age range 3-66 years). They disappeared immediately after a needle biopsy. Breast composition, mammography and US findings, histology and follow-up imaging findings were analyzed.

All 13 patients showed heterogeneously dense (n=5) or extremely dense breast parenchyma (n=8). The most common US findings were an irregular shape (n=7, 54%) and a circumscribed margin (n=7, 54%). All 13 lesions had internal echogenicity and were initially considered as solid masses; 62% (n=8) showed hypoechogenicity and 38% (n=5) had echogenic and anechoic components. Posterior shadowing was seen in 31% (n=4) of the lesions. All 13 lesions have been proven to be fibrocystic changes on biopsy histology. Follow-up US performed for 10 of 13 lesions showed no residual lesion (n=9) or decreased its size (n=1).

An aliasing artifact that appears as a blue-green-red pattern in a breast mass as depicted on US-elastography is suggestive of a possible cystic breast lesion.